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Friday, September 23, 2011

The Morning Drill: September 23, 2011

Dental caries among young rural Alaska Native children are up to 4.5 times as severe as children the same age within the general U.S. population, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC) and the Alaska Department of Health and Social Services.

The report is based on a 2008 investigation of child dental decay in rural Alaska. According to the report, lack of water fluoridation and soda pop consumption were two key factors associated with dental decay severity in both baby and adult teeth.

The authors also found that 4- to 5-year-old children had an average of 2.6 times more decayed and filled primary teeth in nonfluoridated villages than in fluoridated villages. Children 12 to 15 years old in nonfluoridated villages had more than double the number of decayed, missing, and filled permanent teeth than children in that age group living in fluoridated villages.

"Numerous national and international studies have documented the role of water fluoridation in reducing dental decay; however, this is the first such study conducted in Alaska ," said Brad Whistler, DMD, state oral health director and co-author of the study, in a press release announcing the report. "Optimal fluoridation of public water systems is a critical component in protecting the oral health of both young and old Alaskans alike."

A severe shortage of drugs for chemotherapy, infections and other serious ailments is endangering patients and forcing hospitals to buy life-saving medications from secondary suppliers at huge markups because they can't get them any other way.

An Associated Press review of industry reports and interviews with nearly two dozen experts found at least 15 deaths in the past 15 months blamed on the shortages, either because the right drug wasn't available or because of dosing errors or other problems in administering or preparing alternative medications.

The shortages, mainly involving widely-used generic injected drugs that ordinarily are cheap, have been delaying surgeries and cancer treatments, leaving patients in unnecessary pain and forcing hospitals to give less effective treatments. That's resulted in complications and longer hospital stays.

Just over half of the 549 U.S. hospitals responding to a survey this summer by the Institute for Safe Medication Practices, a patient safety group, said they had purchased one or more prescription drugs from so-called "gray market vendors"_ companies other than their normal wholesalers. Most also said they've had to do so more often of late, and 7 percent reported side effects or other problems.

Hospital pharmacists "are really looking at this as a crisis. They are scrambling to find drugs," said Joseph Hill of the American Society of Health-System Pharmacists.

A hearing on the issue was set for Friday before the health subcommittee of the House Energy and Commerce Committee. The Food and Drug Administration is holding a meeting Monday with medical and consumer groups, researchers and industry representatives to discuss the shortages and strategies to fight them.

The FDA says the primary cause of the shortages is production shutdowns because of manufacturing problems, such as contamination and metal particles that get into medicine.

Other reasons:

• Companies abandoning the injected generic drug market because the profit margins are slim. Producing these sterile medicines is far more complicated and expensive than stamping out pills, and it can take about three weeks to produce a batch. Making things worse, companies don't have to notify customers or the FDA that they've stopped making a medicine. That means neither FDA nor competitors can try to fill the gap.

• Only a half-dozen companies make the vast majority of injected generics. Even if other companies wanted to begin making a generic drug in short supply, they're discouraged by the lengthy, expensive process of setting up new manufacturing lines and getting FDA approval.

• Theft of prescription drugs from warehouses or during shipment.

• Secondary, "gray market" vendors who buy scarce drugs from small regional wholesalers, pharmacies or other sources and then market them to hospitals, often at many times the normal price. These sellers may not be licensed, authorized distributors.

As bedbugs have made a comeback, aided by resistance to pesticides and spread by worldwide travel, scientists have found that panic over the blood-sucking pests may be more dangerous than their bite. Some people are misusing poisonous chemicals in a desperate bid to eradicate the pests, federal officials said Thursday.

At least 111 people in seven states — 64 of them in New York City — have been sickened by the overuse or misuse of common pesticides against bedbugs over the last eight years, the federal Centers for Disease Control and Prevention said. One person who became ill, a woman in North Carolina, died after dousing her home and herself with pesticides.

The poisonings serve as a warning, experts said, that people could do more damage to their health by misusing pesticides than they would suffer from the bedbugs, which are upsetting and unpleasant, but not known to be carriers of disease.

“People lose their minds and, yeah, they’ll do a lot of things trying to get rid of them,” said Dini M. Miller, associate professor of urban pest management at Virginia Tech. “Certainly the overapplication of pesticides is one of them.”